[Question #7877] Interpreting Biopsy Report

51 months ago

Hi, I am a male in my early 20s, over the past year I've had a few risky encounters. I just recently got vaccinated for HPV. I went to the dermatologist for some spots I had on my penis, which were Molluscum, and what looked like a small wart on my scrotum. The spot was biopsied. The medical assistant called and said it wasn't HPV. However, after reading the report I am questioning whether it is as the wording is confusing. I wanted to get your expert opinion:

DIAGNOSIS:

Skin, testicle, biopsy:

Verrucous keratosis lesion in anogenital area. See comment.

COMMENT:

No definite HPV effect, high-grade squamous dysplasia or carcinoma is seen. In anogenital skin and adjacent sites, some cutaneous lesions with a similar histology have been found by DNA in situ hybridization to contain human papillomavirus. This finding suggests that some lesions with this histologic appearance may be related to viral wart; however; the histologic differential diagnosis includes seborrheic keratosis unrelated to HPV.

GROSS DESCRIPTION:

A. Other (Specify).

Received in formalin labeled "testicle" is a polypoid piece of gray-tan, rubbery tissue, 0.2 cm in greatest dimension. The resection margin is inked. All/1, no G. cla/lyu

My concern is that in the diagnosis they say Verrucous keratosis, which from my understanding, would indicate HPV?

But then they state no definite HPV effect and mention seborrheic keratosis but I am unsure if it pertains to me?

What is your interpretation of this report, was the spot HPV?

H. Hunter Handsfield, MD

51 months ago

Welcome to the forum. Thanks for your question.

The path report indicates the biopsied lesion is not due to HPV, which was not found. Pathology reports are designed and worded for the health provider who does the biopsy, not the patient. In this case, DNA testing for HPV appaently was not done. The histology (i.e. the appearance of the cells microscopically) indicates the findings are those of HPV, but are typical for seborrheic keratosis -- an entirely different condition than warts. It further advised your doctor that when HPV DNA testing is done, it sometimes is positive even though the histology is not typical. However, that's the case with many skin biopsies. (For example, there is controversy about whether skin tags may be caused by HPV, i.e. are versions of warts. This is probably because asymptomatic genital HPV is present in many entirely normal skin samples -- so its presence in a skin tag doesn't necessarily indicate it caused the growth.)

The bottom line is that the biopsied lesion was a seborrheic keratosis and not a genital wart. SKs are more common in people quite a bit older than you are, but not rare in youger persons. You can google it for detailed information, including photos.

I hope this has helped. Let me know if anything isn't clear.

HHH, MD

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51 months ago

Thanks for the quick response. I do have some follow up questions. One of my encounters last year involved a random woman using a dildo on her vagina and then immediately using it on my anus without much lube and rough as I was bleeding after.

1. Do you recommend following up with a proctologist to investigate internal warts or HPV?

2. What is the likelihood of contracting HPV or another STD this way?

3. If she was the one who gave me Molluscum, could I have got it inside my anus?

During the same encounter we also had unprotected sex, and me giving her oral on her vagina and anus, she squirted a lot in my mouth.

4. What is the likelihood of contracting oral warts or HPV?

5. Would a typical Dentist visit be good enough to have oral warts spotted?

6. If she was the one who gave me Molluscum, could I have got it inside my mouth?

I have noticed several white coated hairs in my pubic hair area. I don't have any itching, pain, or see bite marks.

7. Could I have pubic lice without knowing having any obvious symptoms like pain or itching?

Lastly, I have been dealing with very bad polyuria. Having to go every hour through day and night. If I don't go I am very uncomfortable even if only a little bit comes out. There is no burning when I pee. I've tested negative for all common STDs and have had a normal urinalysis. This makes me think it could be caused by MG or another NGU.

8. Do you recommend having any further testing for this?

Thank you for your help.

H. Hunter Handsfield, MD

51 months ago

Such an event is very low risk for STIs in general, but cannot say zero risk.

1) No, the risk is too low to need exam or testing unless there are symptoms that suggest an infection, like anal discharge, pain or bleeding. And a year later, surely nothing to worry about.

2) No data are available for such an event, but in my opinion very low risk for HPV or other STDs.

3,6) Molluscum is not known to cause infection inside the rectum or mouth. In any case, this exposure probably was not the cause of your diagnosed molluscum, which appears within a few weeks of exposure, not a year later.

4) Oral warts and HPV are very rare after any single sexual encounter.

5) Most dentists surely would likely notice oral warts if present. In any case, this is a rare problem; in my 40+ years in the STD business, I've never seen a patient with oral warts, except a few persons with advanced AIDS.

7) Absence of itching is good evidence against pubic lice.

8) No STD causes polyuria, including M. genitalium.

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